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Taniguchi S, Yamamoto A, D'cruz N. Assessing impaired bed mobility in patients with Parkinson's disease: a scoping review. Physiotherapy 2024; 124:29-39. [PMID: 38870620 DOI: 10.1016/j.physio.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/25/2023] [Accepted: 10/19/2023] [Indexed: 06/15/2024]
Abstract
BACKGROUND Although most patients with Parkinson's disease (PD) experience difficulties in bed mobility, evidence on the suitability of the methods for assessing impaired bed mobility in PD are lacking. OBJECTIVES To identify objective methods for assessing impaired bed mobility in PD and to discuss their clinimetric properties and feasibility for use in clinical practice. DATA SOURCES PubMed, Web of Science, and Cochrane Library were searched between 1995 and 2022. SELECTION CRITERIA Studies were included if they described an objective assessment method for assessing impaired bed mobility in PD. DATA EXTRACTION AND DATA SYNTHESIS Characteristics of the identified measurement methods such as clinimetric properties and feasibility were extracted by two authors. The methodological quality of studies was evaluated using the Appraisal of studies tool. RESULTS Twenty-three studies were included and categorised into three assessment methods: sensor-based assessments (48%), rating scales (39%), and timed-tests (13%). The risk of bias was low for all but one study, which was medium. LIMITATIONS Despite applying wide selection criteria, a relatively small number of studies were identified in our results. CONCLUSION Rating scales may be the most preferred for assessing impaired bed mobility in PD in clinical practice, until clinimetric validity are adequately demonstrated in the other assessment methods. CONTRIBUTION OF PAPER.
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Affiliation(s)
- Seira Taniguchi
- Department of Neurology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, Japan.
| | - Ariko Yamamoto
- Department of Rehabilitation, Tekijyu Rehabilitation Hospital, Hanayamacho 2-11-32, Kobe, Hyogo, Japan
| | - Nicholas D'cruz
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Tervuursevest 101, PO Box1501, Leuven, Belgium
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Hutin E, Poirier T, Meimoun M, Mardale V, Ghédira M. Model-based cueing-as-needed for walking in Parkinson's disease: A randomized cross-over study. Rev Neurol (Paris) 2024:S0035-3787(24)00532-0. [PMID: 38834484 DOI: 10.1016/j.neurol.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/29/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Correcting of the lack of regularity in steps is a key component of gait rehabilitation in Parkinson's disease. We proposed to introduce adaptive spatial auditory cueing (ASAC) based on verbal instruction "lengthen the step" automatically delivered when the stride length decreased below a predetermined threshold. OBJECTIVES The present study compared the effect of usual rhythmic auditory cueing versus ASAC used during a walking training in Parkinson's disease. METHODS Fifteen patients with Parkinson's disease performed both interventions in randomized order, one week apart: a 20-minute walking training with rhythmic auditory cueing, in form of a metronome adjusted on 110% of the patient's own cadence, or ASAC delivered when the stride length is less than 110% of the patient's own stride length. Assessment criteria were walking distance covered during the intervention, speed, step length, cadence, coefficients of variation of step length and step duration, and indexes of spatial and temporal asymmetry during a walking test before and just after the intervention. RESULTS The walking distance is higher with ASAC compared with rhythmic auditory cueing (rhythmic auditory cueing, 905 (203) m, mean (standard deviation); ASAC, 1043 (212) m; P=0.002). Between-intervention comparison showed some similar effects on walking after the intervention including free speed and step length increases (P<0.05). CONCLUSION The distance covered during 20-minute walking with ASAC increases by 15% compared to the use of classical rhythmic auditory cueing, while the immediate therapeutic effects show similar spatial-temporal benefits on short-distance walking. Auditory biofeedback cueing promoting the increase in step length might improve gait relearning in Parkinson's disease.
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Affiliation(s)
- E Hutin
- Laboratoire Analyse et Restauration du Mouvement (ARM), Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri-Mondor, AP-HP, 1, rue Gustave-Eiffel, 94010 Créteil cedex, France.
| | - T Poirier
- Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | - M Meimoun
- Laboratoire Analyse et Restauration du Mouvement (ARM), Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri-Mondor, AP-HP, 1, rue Gustave-Eiffel, 94010 Créteil cedex, France
| | - V Mardale
- Laboratoire Analyse et Restauration du Mouvement (ARM), Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri-Mondor, AP-HP, 1, rue Gustave-Eiffel, 94010 Créteil cedex, France; Service de Médecine Physique et de Réadaptation, Hôpital Dupuytren, AP-HP, 1, avenue Eugène-Delacroix, 91210 Draveil, France
| | - M Ghédira
- Laboratoire Analyse et Restauration du Mouvement (ARM), Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri-Mondor, AP-HP, 1, rue Gustave-Eiffel, 94010 Créteil cedex, France
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Taniguchi S, Yamamoto A. Measurement instruments to assess basic functional mobility in Parkinson's Disease: A systematic review of clinimetric properties and feasibility for use in clinical practice. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2023; 14:16-25. [PMID: 37859792 PMCID: PMC10585016 DOI: 10.11336/jjcrs.14.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 10/21/2023]
Abstract
Taniguchi S, Yamamoto A. Measurement instruments to assess basic functional mobility in Parkinson's Disease: A systematic review of clinimetric properties and feasibility for use in clinical practice. Jpn J Compr Rehabil Sci 2023; 14: 16-25. Objective To systematically review the evaluation of clinimetric properties and feasibility of the "Modified Parkinson Activity Scale (M-PAS)" and the "Lindop Parkinson's Disease Mobility Assessment (LPA)," which are Parkinson's Disease (PD)-specific measurement instruments to assess basic functional mobility, and to discuss their considerations for use in clinical practice. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A risk of bias assessment was also performed. Results Eleven studies were included: five studies used M-PAS (45%), five studies used LPA (45%), and one study used M-PAS and LPA (13%). The risk of bias was low for all evaluated studies. Conclusion M-PAS and LPA showed adequate reliability, validity, and responsiveness in detecting intervention changes. M-PAS has more detailed qualitative scoring options, a lack of ceiling effect, and can be used by a non-expert in PD.In contrast, the drawback of M-PAS is that it is time-consuming to apply in everyday clinical practice. On the other hand, LPA with greater simplicity may lead to lower burdens for both patients and raters in situations with strict time limitations. Further research is required to identify new resources.
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Affiliation(s)
- Seira Taniguchi
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ariko Yamamoto
- Division of ward management, Tekiju Rehabilitation Hospital, Kobe, Hyogo, Japan
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Training in varying environmental contexts facilitates transfer of improved gait performance to new contexts for individuals with Parkinson's disease - a randomized controlled trial. Arch Phys Med Rehabil 2022; 103:1917-1923. [PMID: 35810822 DOI: 10.1016/j.apmr.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/06/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate whether varying practice context during gait training could reduce context-dependency and facilitate transfer of improved gait performance to a new context. DESIGN A single-blind, parallel-group randomized controlled trial. SETTING Medical university rehabilitation settings. PARTICIPANTS Forty-nine participants with PD were recruited and randomized into the constant (CONS) or varied (VARI) context group. INTERVENTIONS All participants received 12 sessions of treadmill and over-ground gait training. The CONS group was trained in a constant environmental context throughout the study, while the VARI group received training in 2 different contexts in an alternating order. MAIN OUTCOME MEASURES The primary outcome was gait performance, including velocity, cadence, and stride length. The participants were assessed in the original training context as well as in a novel context at post-test to determine the influence of changed environmental context on gait performance. RESULTS While both groups improved significantly after training, the CONS group showed greater improvement in stride length than the VARI group when assessed in the original practice context. However, the CONS group showed a decreased velocity and stride length in the novel context, while the VARI group maintained their performance. CONCLUSIONS Varying practice context could facilitate transfer of improved gait performance to a novel context.
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Koyanagi Y, Fukushi I, Nakamura M, Suzuki K, Oda N, Aita T, Seki H. The effect of body weight-supported overground gait training for patients with Parkinson's disease: A retrospective case-control observational study. PLoS One 2021; 16:e0254415. [PMID: 34283843 PMCID: PMC8291710 DOI: 10.1371/journal.pone.0254415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/25/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the effects of body weight-supported overground gait training (BWSOGT) on motor abilities, such as gait and balance, in patients with Parkinson’s disease (PD). Design Retrospective case-controlled observational study with a 4-week follow-up. Setting Inpatient rehabilitation. Participants We selected 37 of 68 patients with PD. Inclusion criteria were (1) Hoehn & Yahr stage II–IV, (2) no medication adjustment during the study period, (3) at least 1 week since last medication adjustment, and (4) ability to walk more than 10 meters on their own. Exclusion criteria were (1) cerebrovascular disease or other complications affecting movement, (2) difficulty in measurement, (3) early discharge, (4) medication change during the study, and (5) development of complications. Interventions Patients were divided into two groups. Patients in Group I underwent 20 minutes of BWSOGT with a mobile hoist in addition to the standard exercises; Group II performed 20 minutes of gait training in place of BWSOGT. In both groups, training was performed for a total of 15 times/4 weeks. Main outcome measure(s) Participants were evaluated using the Unified Parkinson’s Disease Rating Scale total, part II, and part III; 10-m walk test; velocity; stride length; 6-minute walk test; timed up and go test; Berg Balance Scale; and freezing of gait before and after the intervention. Results There were significant decreases in the Unified Parkinson’s Disease Rating Scale total, part II, and part III in both groups; however, 6-minute walk test, timed up and go test, and freezing of gait results only improved in Group I. Conclusions BWSOGT for patients with PD improves gait ability and dynamic balance more than standard gait training.
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Affiliation(s)
- Yasuki Koyanagi
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
- * E-mail:
| | - Isato Fukushi
- Faculty of Health Sciences, Uekusa Gakuen University, Chiba, Japan
- Clinical Research Center, Murayama Medical Center, Musashimurayama, Japan
| | - Masatoshi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kouji Suzuki
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
| | - Nobuhito Oda
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
| | - Takashi Aita
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
| | - Hareaki Seki
- Department of Neurology and Rehabilitation, National Hospital Organization Iwaki Hospital, Iwaki, Japan
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Dalla Bella S. Music and movement: Towards a translational approach. Neurophysiol Clin 2018; 48:377-386. [PMID: 30396753 DOI: 10.1016/j.neucli.2018.10.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 12/21/2022] Open
Abstract
Rhythmic abilities are highly widespread in the general population. Most people can extract the regular beat of music, and align their movements with it. The aim of a translational approach for music and movement is to build on current fundamental research and theories of beat perception and synchronization to devise music-based interventions, which are informed by theory. To illustrate this approach, Parkinson's disease is taken as a model, with a focus on the positive effects of rhythmic auditory cueing on walking. In Parkinson's disease, a relation is found between the success of this music-based intervention and individual differences in rhythmic abilities. Patients with relatively spared rhythmic abilities are the most likely to benefit from cueing. Moreover, rhythmic auditory cueing can be optimized by using mobile technologies (tablets and smartphones), in the form of dedicated apps or serious games. A similar translational approach to the study of music, rhythm, and movement can be extended to remediation of cognitive, speech and language functions in other patient populations, such as children and adults with neurodevelopemental disorders.
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Affiliation(s)
- Simone Dalla Bella
- International Laboratory for Brain, Music, and Sound Research (BRAMS), Montreal, Canada; Department of Psychology, University of Montreal, Montreal, Canada; Centre for Research on Brain, Language and Music (CRBLM), Montreal, Canada.
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Qamar MA, Harington G, Trump S, Johnson J, Roberts F, Frost E. Multidisciplinary Care in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:511-523. [PMID: 28554420 DOI: 10.1016/bs.irn.2017.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is now known to be a multisystemic and multipeptide neurodegenerative disorder, whereby patients have an array of symptoms both motor and nonmotor. Nonmotor features of PD have been shown to arise almost 15-20 years prior to motor symptoms and, as such, are also a key determinant to the quality of life of a patient. Therefore, there is increasing evidence that a PD patient's management must encompass a multidisciplinary approach to effectively manage and treat the patient's PD and also their individual symptoms. Therefore, the notion that a PD nurse specialist and a neurologist are the only key players, is no longer the case. Rather, the involvement of speech and language therapist, physiotherapists, palliative care, and others is vital for a patient's recovery and their effective management. Here we discuss a few professions who should ideally be present for each PD patient.
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Affiliation(s)
- Mubasher A Qamar
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom; Maurice Wohl Clinical Neuroscience Institute, Kings College, London, United Kingdom.
| | - Grace Harington
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sally Trump
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Julia Johnson
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Fiona Roberts
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emily Frost
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Radder DL, Sturkenboom IH, van Nimwegen M, Keus SH, Bloem BR, de Vries NM. Physical therapy and occupational therapy in Parkinson's disease. Int J Neurosci 2017; 127:930-943. [DOI: 10.1080/00207454.2016.1275617] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Danique L.M. Radder
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid H. Sturkenboom
- Department of Rehabilitation-Occupational Therapy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marlies van Nimwegen
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Samyra H. Keus
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nienke M. de Vries
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
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Masters RSW, Pall HS, MacMahon KMA, Eves FF. Duration of Parkinson Disease Is Associated With an Increased Propensity for “Reinvestment”. Neurorehabil Neural Repair 2016; 21:123-6. [PMID: 17312087 DOI: 10.1177/1545968306290728] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. As a consequence of difficulties in movement initiation and execution, people with Parkinson’s disease (PD) are typically encouraged to consciously monitor and control the mechanics of their actions. This is described as ‘reinvestment’ and has been shown to help mediate effective motor output. Paradoxically, in situations where people with PD are particularly motivated to move effectively, reinvestment may exacerbate existing movement deficits. Objective. To examine the propensity for reinvestment in a sample of people with PD. Methods. A volunteer sample of 55 people with PD was asked to complete a previously validated measure, the Reinvestment Scale. A sub-sample (and age matched controls) was asked to complete a recently developed, movement specific, version of the Scale. Data was collected on Mini Mental State Examination and the Hoehn & Yahr Scale. Participant demographics, including age of onset and duration of disease, were also collated. Results. Multiple regression analyses showed that duration of disease was associated with reinvestment score on both the Reinvestment Scale and the Movement Specific Reinvestment Scale. Conclusions. Participants appeared to become more aware of the mechanics of their actions over time. Possible explanations for this finding are discussed with reference to rehabilitation.
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Affiliation(s)
- R S W Masters
- Institute of Human Performance, University of Hong Kong, Hong Kong, China.
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Cholewa J, Gorzkowska A, Kunicki M, Stanula A, Cholewa J. Continuation of full time employment as an inhibiting factor in Parkinson’s disease symptoms. Work 2016; 54:569-75. [DOI: 10.3233/wor-162305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Joanna Cholewa
- The J. Kukuczka Academy of Physical Education, Katowice, Poland
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Brichetto G, Pelosin E, Marchese R, Abbruzzese G. Evaluation of physical therapy in parkinsonian patients with freezing of gait: a pilot study. Clin Rehabil 2016; 20:31-5. [PMID: 16502747 DOI: 10.1191/0269215506cr913oa] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Freezing of gait is a frequently disabling symptom in Parkinson's disease, poorly responding to dopaminergic treatment. We investigated the short-term effectiveness of a rehabilitation protocol in parkinsonian patients with freezing of gait. Design: Prospective, uncontrolled pilot study with open label design. Setting: Outpatient service for rehabilitation of neurological disorders. Subjects: Twelve patients (8 male, 4 female; aged 59-78 years; Hoehn-Yahr stage: 2-3; mean disease duration: 14.29±SD 4.1 years). Interventions: Patients attended three (45 min) sessions every week, over a six-week period, of physical therapy focused to improve balance, postural control and walking, and to learn new strategies for overcoming freezing of gait. Main outcome measures: Patients were evaluated before (T0), at the end (T1), and one month after (T2) rehabilitation by means of clinical rating scales (Unified Parkinson Disease Rating Scale-Motor Section; Freezing of Gait Questionnaire; Parkinson Disease Quality of Life Score) and gait parameters (number of strides, stride length and velocity) during a standardized walking test. Results: The scores of Freezing of Gait Questionnaire and of Parkinson Disease Quality of Life Questionnaire (but not of the Unified Parkinson Disease Rating Scale-Motor Section) were significantly improved after treatment (T1). Gait parameters were significantly improved at T1 and T2. Conclusions: We showed the potential short-term efficacy of a rehabilitative approach to freezing of gait in Parkinson's disease. The positive outcome was documented by clinical rating scales and objective gait evaluation. The rapid reversibility of the clinical benefit suggests that further studies are needed to better define the optimal frequency and duration of treatment.
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Affiliation(s)
- G Brichetto
- Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Italy
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Lim I, van Wegen E, de Goede C, Deutekom M, Nieuwboer A, Willems A, Jones D, Rochester L, Kwakkel G. Effects of external rhythmical cueing on gait in patients with Parkinson's disease: a systematic review. Clin Rehabil 2016; 19:695-713. [PMID: 16250189 DOI: 10.1191/0269215505cr906oa] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To critically review studies evaluating the effects of external rhythmical cueing on gait in patients with Parkinson's disease. Methods: Articles published from 1966 to January 2005 were searched by two physiotherapists in MEDLINE, PiCarta, PEDRo, Cochrane, DocOnline, CINAHL and SUMSEARCH. To be included, articles had to investigate the effects of external rhythmical cueing (i.e., auditory, visual or tactile cueing) on gait parameters in patients with idiopathic Parkinson's disease. Both controlled and noncontrolled studies were included. Based on the type of design and methodological quality a meta-analysis or best-evidence synthesis was applied. Results: Twenty-four studies (total number of patients = 626) out of the 159 screened studies were evaluated in this systematic review. Two out of 24 were randomized controlled trails (RCT), both of high methodological quality. One RCT did not focus specifically on external rhythmical cueing of individual patients with Parkinson's disease, but on group exercises in general, including walking with cues. All other studies were pre-experimental studies. Best-evidence synthesis showed strong evidence for improving walking speed with the help of auditory cues. Insufficient evidence was found for the effectiveness of visual and somatosensory cueing. Conclusion: Only one high-quality study, specifically focused on the effects of auditory rhythmical cueing, suggesting that the walking speed of patients with Parkinson's disease can be positively influenced. However, it is unclear whether positive effects identified in the laboratory can be generalized to improved activities of daily living (ADLs) and reduced frequency of falls in the community. In addition, the sustainability of a cueing training programme remains uncertain.
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Affiliation(s)
- I Lim
- Department of Physiotherapy, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Zinzi P, Salmaso D, De Grandis R, Graziani G, Maceroni S, Bentivoglio A, Zappata P, Frontali M, Jacopini G. Effects of an intensive rehabilitation programme on patients with Huntington's disease: a pilot study. Clin Rehabil 2016; 21:603-13. [PMID: 17702702 DOI: 10.1177/0269215507075495] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the effects of an intensive, inpatient rehabilitation programme on individuals affected by Huntington's disease. Design: A pilot study. Within-subjects design. Setting: Inpatient rehabilitation home of the Italian welfare system. Subjects: Forty patients, early and middle stage of the disease, were recruited to an intensive, inpatient rehabilitation protocol. Interventions: The treatment programme included respiratory exercises and speech therapy, physical and occupational therapy and cognitive rehabilitation exercises. The programme involved three-week admission periods of intensive treatment that could be repeated three times a year. Main measures: A standard clinical assessment was performed at the beginning of each admission using the Zung Depression Scale, Mini-Mental State Examination (MMSE), Barthel Index, Tinetti Scale and Physical Performance Test (PPT). Tinetti and PPT were also used at the end of each admission to assess the outcomes in terms of motor and functional performance. Results: Each three-week period of treatment resulted in highly significant ( P < 0.001) improvements of motor performance and daily life activities. The average increase was 4.7 for Tinetti and 5.21 for PPT scores. No carry-over effect from one admission to the next was apparent but at the same time, no motor decline was detected over two years, indicating that patients maintained a constant level of functional, cognitive as well as motor performance. Conclusions: Intensive rehabilitation treatments may positively influence the maintenance of functional and motor performance in patients with Huntington's disease.
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Caglar AT, Gurses HN, Mutluay FK, Kiziltan G. Effects of home exercises on motor performance in patients with Parkinson's disease. Clin Rehabil 2016; 19:870-7. [PMID: 16323386 DOI: 10.1191/0269215505cr924oa] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect of home exercises on the motor performance of patients with Parkinson's disease. Design: A prospective blinded study with allocation of patients into their groups by alternate weeks. Setting: A University Hospital neurology and physiotherapy department. Subjects: Recruited from a movement disorders outpatient clinic of Cerrahpasa School of Medicine diagnosed with Parkinson's disease, classified as Hoehn and Yahr Grades I, II and III. Interventions: Patients who fulfilled the inclusion criteria were recruited to the study. Each patient was evaluated at the end of first and second month after the baseline evaluation. Patients were divided into two groups. Those in the first and third week were put in the exercise group and second and fourth week in the control group. Patients in the exercise group (n=15) were given a schedule of exercises to undertake at home; the others (n=15) did not receive this instruction. Measures: Ten- and 20-m walking test, first pace length, pace number in 10 m, walking around a chair, Nine Hole Peg Board (NHPB) test. Results: Following the home exercise programme, patients in the exercise group showed improvement in walking 10 and 20 m, time elapsed to complete walking around a chair and length of the first pace length, and in the motor performance of both hands (p < 0.001). Conclusions: A home-based rehabilitation programme for patients with Parkinson's disease helped to improve motor performance compared to patients who did not take advantage of a regular, professionally designed exercise programme.
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Affiliation(s)
- A T Caglar
- Istanbul University, Neurology Department, Cerrahpasa School of Medicine, Turkey
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Lee YY, Winstein CJ, Gordon J, Petzinger GM, Zelinski EM, Fisher BE. Context-Dependent Learning in People With Parkinson's Disease. J Mot Behav 2015; 48:240-8. [PMID: 26375786 DOI: 10.1080/00222895.2015.1082964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Context-dependent learning is a phenomenon in which people demonstrate superior performance in the context in which they originally learned a skill but perform less well in a novel context. This study investigated context-dependent learning in people with Parkinson's disease (PD) and age-matched nondisabled adults. All participants practiced 3 finger sequences, each embedded within a unique context (colors and locations on a computer screen). One day after practice, the participants were tested either under the sequence-context associations remained the same as during practice, or the sequence-context associations were changed (SWITCH). Compared with nondisabled adults, people with PD demonstrated significantly greater decrement in performance (especially movement time) under the SWITCH condition, suggesting that individuals with PD are more context dependent than nondisabled adults.
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Affiliation(s)
- Ya-Yun Lee
- a Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles.,b Healthy Aging Research Center, Chang Gung University , Taoyuan , Taiwan
| | - Carolee J Winstein
- a Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles
| | - James Gordon
- a Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles
| | - Giselle M Petzinger
- c Department of Neurology , Division for Movement Disorders, Keck School of Medicine, University of Southern California , Los Angeles
| | | | - Beth E Fisher
- a Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles.,c Department of Neurology , Division for Movement Disorders, Keck School of Medicine, University of Southern California , Los Angeles
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Bhidayasiri R, Jitkritsadakul O, Boonrod N, Sringean J, Calne SM, Hattori N, Hayashi A. What is the evidence to support home environmental adaptation in Parkinson's disease? A call for multidisciplinary interventions. Parkinsonism Relat Disord 2015; 21:1127-32. [PMID: 26365779 DOI: 10.1016/j.parkreldis.2015.08.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/16/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022]
Abstract
"Home" is where one has a sense of belonging and feels secure, but it can also be a risky place for people with Parkinson's disease (PD). PD patients need assistance making adjustments to their physical environment to maintain appropriate care and provide a safe environment. This relationship is called the "person-environmental fit" (P-E fit). While most PD patients remain in their own homes, little is known about the specific challenges that PD patients and their caregivers encounter in the routine activities of daily living. The aim of our study was to identify the existing evidence on the issue of housing environmental adaptation in PD by performing a systematic review with a proposal of development strategies to integrate a multidisciplinary team into a home environmental research. MEDLINE, and life science journals were searched by querying appropriate key words, but revealed very few publications in this area. However, early evidence suggested that PD patients do not enjoy an adequate P-E fit in their own homes and face more functional limitations compared to matched controls. We concluded that we need to develop research-based evaluation strategies that can provide us with a theoretical and conceptual basis as well as tools for analysis of the P-E fit for PD patients and caregivers. We recommend that individual members of the multidisciplinary team including patients, caregivers, physicians, rehabilitation specialists, and social workers use a team approach to identify the key indicators and solutions for the development of PD-specific solutions for improving the P-E fit.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
| | - Onanong Jitkritsadakul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Nonglak Boonrod
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Susan M Calne
- Pacific Parkinson's Research Center, University of British Columbia, Vancouver, Canada
| | | | - Akito Hayashi
- Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
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Effects of amplitude cueing on postural responses and preparatory cortical activity of people with Parkinson disease. J Neurol Phys Ther 2015; 38:207-15. [PMID: 25198870 DOI: 10.1097/npt.0000000000000058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Persons with Parkinson disease (PD) are unable to modify their postural responses, and show an associated increase in cortical preparatory activity for anticipated postural perturbations. In this study we asked whether participants with PD could modify their postural responses and cortical preparatory activity when cued to focus on increasing movement amplitude before a series of predictable postural perturbations. METHODS Twelve participants with PD performed postural responses to 30 identical backward surface translations. We cued participants to focus on increasing movement amplitude, and examined the effects of cueing by measuring postural responses (center-of-pressure initial rate of change, automatic postural response stability, peak trunk flexion, peak ankle extension) and preparatory cortical activity (electroencephalographic measures of contingent negative variation, alpha and beta event-related desynchronization). RESULTS Participants with PD modified their postural responses during the amplitude trials by increasing trunk flexion, slowing center-of-pressure initial rate of change, and decreasing automatic postural response stability. However, no significant differences in contingent negative variation amplitude or alpha or beta event-related desynchronization were observed with versus without amplitude cueing. DISCUSSION AND CONCLUSIONS Persons with PD were able to modify their feet-in-place postural responses with amplitude cueing. These changes were not associated with changes in cortical preparation during amplitude cue trials, suggesting that other regions or measures of brain function were responsible for changes in postural responses. Future studies are needed to determine the effects of long-term amplitude-cueing practice on cortical preparation and postural stability.Video Abstract available. See Video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A78) for more insights from the authors.
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Rocha PA, Porfírio GM, Ferraz HB, Trevisani VFM. Effects of external cues on gait parameters of Parkinson's disease patients: A systematic review. Clin Neurol Neurosurg 2014; 124:127-34. [PMID: 25043443 DOI: 10.1016/j.clineuro.2014.06.026] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Priscila A Rocha
- Universidade Federal de São Paulo/Escola Paulista de Medicina-UNIFESP/EPM, Urgency Medicine and Medicine based in Evidence, São Paulo, SP, Brazil.
| | - Gustavo M Porfírio
- Universidade Federal de São Paulo/Escola Paulista de Medicina-UNIFESP/EPM, Urgency Medicine and Medicine based in Evidence, São Paulo, SP, Brazil
| | - Henrique B Ferraz
- Universidade Federal de São Paulo/Escola Paulista de Medicina-UNIFESP/EPM, Neurology, São Paulo, SP, Brazil
| | - Virginia F M Trevisani
- Universidade Federal de São Paulo/Escola Paulista de Medicina-UNIFESP/EPM, Urgency Medicine and Medicine based in Evidence, São Paulo, SP, Brazil
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Benoit CE, Dalla Bella S, Farrugia N, Obrig H, Mainka S, Kotz SA. Musically cued gait-training improves both perceptual and motor timing in Parkinson's disease. Front Hum Neurosci 2014; 8:494. [PMID: 25071522 PMCID: PMC4083221 DOI: 10.3389/fnhum.2014.00494] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/18/2014] [Indexed: 11/13/2022] Open
Abstract
It is well established that auditory cueing improves gait in patients with idiopathic Parkinson's disease (IPD). Disease-related reductions in speed and step length can be improved by providing rhythmical auditory cues via a metronome or music. However, effects on cognitive aspects of motor control have yet to be thoroughly investigated. If synchronization of movement to an auditory cue relies on a supramodal timing system involved in perceptual, motor, and sensorimotor integration, auditory cueing can be expected to affect both motor and perceptual timing. Here, we tested this hypothesis by assessing perceptual and motor timing in 15 IPD patients before and after a 4-week music training program with rhythmic auditory cueing. Long-term effects were assessed 1 month after the end of the training. Perceptual and motor timing was evaluated with a battery for the assessment of auditory sensorimotor and timing abilities and compared to that of age-, gender-, and education-matched healthy controls. Prior to training, IPD patients exhibited impaired perceptual and motor timing. Training improved patients' performance in tasks requiring synchronization with isochronous sequences, and enhanced their ability to adapt to durational changes in a sequence in hand tapping tasks. Benefits of cueing extended to time perception (duration discrimination and detection of misaligned beats in musical excerpts). The current results demonstrate that auditory cueing leads to benefits beyond gait and support the idea that coupling gait to rhythmic auditory cues in IPD patients relies on a neuronal network engaged in both perceptual and motor timing.
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Affiliation(s)
- Charles-Etienne Benoit
- Department of Cognitive Psychology, University of Finance and Management in Warsaw, Warsaw, Poland
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Movement to Health Laboratory (M2H), EuroMov, Montpellier-1 University, Montpellier, France
| | - Simone Dalla Bella
- Department of Cognitive Psychology, University of Finance and Management in Warsaw, Warsaw, Poland
- Movement to Health Laboratory (M2H), EuroMov, Montpellier-1 University, Montpellier, France
- Institut Universitaire de France, Paris, France
| | - Nicolas Farrugia
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Goldsmiths, University of London, London, UK
| | - Hellmuth Obrig
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University Hospital, University of Leipzig, Leipzig, Germany
| | - Stefan Mainka
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Beelitz-Heilstätten, Germany
| | - Sonja A. Kotz
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- School of Psychological Sciences, The University of Manchester, Manchester, UK
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Archibald N, Miller N, Rochester L. Neurorehabilitation in Parkinson disease. HANDBOOK OF CLINICAL NEUROLOGY 2013; 110:435-42. [PMID: 23312662 DOI: 10.1016/b978-0-444-52901-5.00037-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Parkinson disease (PD) is the second commonest neurodegenerative disorder in the UK with an increasing prevalence in our aging population. The clinical features of PD are varied with a variety of "motor" and "nonmotor" symptoms and the condition is best thought of as a multisystem neurodegenerative disorder rather than as a "pure" movement disorder. Although the mainstay of treatment is pharmacological, nonpharmacological interventions are vital as part of a multidisciplinary approach to the disorder. Neurorehabilitative interventions have been used for some time in the treatment of PD but, until recently, there has been little evidence to support the clinical impression that physiotherapy, occupational therapy, and speech and language therapy have a positive impact on both motor and nonmotor symptoms. This chapter will review the current evidence base for neurorehabilitation in PD and discuss the challenges of service provision within healthcare systems.
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Affiliation(s)
- Neil Archibald
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, UK.
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Influence of physiotherapy on severity of motor symptoms and quality of life in patients with Parkinson disease. Neurol Neurochir Pol 2013; 47:256-62. [DOI: 10.5114/ninp.2013.35774] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Santos VV, Araújo MA, Nascimento OJM, Guimarães FS, Orsini M, Freitas MRGD. Effects of a physical therapy home-based exercise program for Parkinson's disease. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000400003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Parkinson's disease (PD) is a neurological disorder that causes loss of functional abilities and independence. The aim of this study was to evaluate the effects of a physical therapist-supervised home-based exercise program in patients with PD using the UPDRS scale. MATERIALS AND METHODS: Thirty-three PD patients in the 1.5 to 3 Hoehn and Yahr stages participated in the trial. The patients and their relatives received a booklet with a 12-week home program, with a series of strengthening, stretching and flexibility exercises. The patients were trained by a physical therapist, and each session took 60 minutes, three times a week. RESULTS: We classified our patients in four groups: Group 1 - patients under 60 years of age and less than five years of PD; Group 2 - patients under 60 years of age and more than five years of PD; Group 3 - patients over 60 years of age and less than five years of the disease; and Group 4 - patients over 60 years of age and more than five years of PD. Significant improvement was found in group 1 in mentation, activities of daily living and motor function (p > 0.05). Group 3 presented statistically significant differences in motor function subscale (p > 0.05) and Group 4 showed no worsening in mentation subscale (p > 0.05). Group 2, however, presented no difference in all subscales (p < 0.05). CONCLUSION: Although not all patients improved their UPDRS scores, our data support the use of a home program as an alternative method of physical therapy treatment for PD patients.
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Adherence to use of a home-based exercise DVD in people with Huntington disease: participants' perspectives. Phys Ther 2012; 92:69-82. [PMID: 21960468 DOI: 10.2522/ptj.20100438] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Individualized exercise instruction on a regular basis may be desirable for people with Huntington disease (HD). Sustained interventions, however, may not be the most feasible for lifelong disease management. It is critical, therefore, for physical therapists to find ways to facilitate engagement in independent exercise programs. The capabilities of DVD technology can make the DVD a useful format to facilitate engagement for people with HD who have motivational and cognitive problems. OBJECTIVE The purpose of this study was to explore how people with HD used a home-based exercise DVD and how it was perceived by the participants and their caregivers. DESIGN An exploratory, mixed-method design was used in this study. METHODS Fifteen participants with HD were provided with an exercise DVD, developed by the authors, to support their engagement in a home-based exercise program. Exercise diaries were used to record adherence rates. Semistructured interviews were conducted to explore what factors affected the usability of the DVD. Conversations were audio recorded and fully transcribed. Content analysis approach was used to analyze the interviews. RESULTS Most of the participants (11/15, 73.3%) adhered well to the use of the DVD. Participants felt that the exercises were suitable. Commitment of the caregiver as a key to the success of the program was the main theme that emerged from the data. Participants identified barriers and facilitators that affected adherence to using the exercise DVD and described management strategies that helped promote adherence to the exercise program. CONCLUSIONS The DVD was perceived to be suitable and supportive. The DVD could be appropriate for use in supporting people with HD to engage in exercise at home, either outside of therapy sessions or upon completion of a therapy program.
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Vitório R, Teixeira-Arroyo C, Lirani-Silva E, Barbieri FA, Caetano MJD, Gobbi S, Stella F, Teresa Bucken Gobbi L. Effects of 6-month, Multimodal Exercise Program on Clinical and Gait Parameters of Patients with Idiopathic Parkinson's Disease: A Pilot Study. ISRN NEUROLOGY 2011; 2011:714947. [PMID: 22389827 PMCID: PMC3263544 DOI: 10.5402/2011/714947] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/07/2011] [Indexed: 11/23/2022]
Abstract
This pilot study aimed to identify the effects of a 6-month, multimodal exercise program on clinical and gait parameters in patients with Parkinson's disease. Two groups of participants were enrolled in the study: Trained Group (TG) and Control Group (CG). Individuals in the TG exercised three times a week for 24 weeks (in a multimodal exercise program), while the CG participants maintained their regular activity level. Participants in both the TG and the CG were assessed at pre- and posttest by clinical rates and the spatiotemporal parameters of self-paced walking. The two groups were not significantly different in demographic, clinical, and gait data at baseline. There were no significant differences between groups for clinical data at posttest. The purposed multimodal exercise program has found improvement in some kinematic gait parameters for the TG. Further study in the form of randomized controlled trial would be required to establish effectiveness of the intervention.
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Affiliation(s)
- Rodrigo Vitório
- UNESP-São Paulo State University, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
- Gait and Posture Studies Laboratory, Physical Education Department-UNESP, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
| | - Claudia Teixeira-Arroyo
- UNESP-São Paulo State University, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
- Gait and Posture Studies Laboratory, Physical Education Department-UNESP, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
| | - Ellen Lirani-Silva
- UNESP-São Paulo State University, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
- Gait and Posture Studies Laboratory, Physical Education Department-UNESP, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
| | - Fabio Augusto Barbieri
- UNESP-São Paulo State University, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
- Gait and Posture Studies Laboratory, Physical Education Department-UNESP, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
| | | | - Sebastião Gobbi
- UNESP-São Paulo State University, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
| | - Florindo Stella
- UNESP-São Paulo State University, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
- UNICAMP-Campinas State University, SP, Brazil
| | - Lilian Teresa Bucken Gobbi
- UNESP-São Paulo State University, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
- Gait and Posture Studies Laboratory, Physical Education Department-UNESP, Avenue 24-A-1515, 13506-900 Rio Claro, SP, Brazil
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The PIT: SToPP Trial-A Feasibility Randomised Controlled Trial of Home-Based Physiotherapy for People with Parkinson's Disease Using Video-Based Measures to Preserve Assessor Blinding. PARKINSONS DISEASE 2011; 2012:360231. [PMID: 22046578 PMCID: PMC3199203 DOI: 10.1155/2012/360231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 08/22/2011] [Indexed: 11/25/2022]
Abstract
Purpose. To trial four-week's physiotherapy targeting chair transfers for people with Parkinson's disease (PwPD) and explore the feasibility of reliance on remote outcome measurement to preserve blinding. Scope. We recruited 47 PwPD and randomised 24 to a focused home physiotherapy programme (exercise, movement strategies, and cueing) and 23 to a control group. We evaluated transfers (plus mobility, balance, posture, and quality of life) before and after treatment and at followup (weeks 0, 4, 8, and 12) from video produced by, and questionnaires distributed by, treating physiotherapists. Participants fed back via end-of-study questionnaires. Thirty-five participants (74%) completed the trial. Excluding dropouts, 20% of questionnaire data and 9% of video data were missing or unusable; we had to evaluate balance in situ. We noted trends to improvement in transfers, mobility, and balance in the physiotherapy group not noted in the control group. Participant feedback was largely positive and assessor blinding was maintained in every case. Conclusions. Intense, focused physiotherapy at home appears acceptable and likely to bring positive change in those who can participate. Remote outcome measurement was successful; questionnaire followup and further training in video production would reduce missing data. We advocate a fully powered trial, designed to minimise dropouts and preserve assessor blinding, to evaluate this intervention.
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Vivas J, Arias P, Cudeiro J. Aquatic Therapy Versus Conventional Land-Based Therapy for Parkinson's Disease: An Open-Label Pilot Study. Arch Phys Med Rehabil 2011; 92:1202-10. [DOI: 10.1016/j.apmr.2011.03.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/09/2011] [Accepted: 03/16/2011] [Indexed: 10/17/2022]
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Portillo MC, Cowley S. Social rehabilitation in long-term conditions: learning about the process. J Adv Nurs 2011; 67:1329-40. [PMID: 21366671 DOI: 10.1111/j.1365-2648.2010.05600.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study of the process of social rehabilitation, and the analysis of the main elements and influencing factors which are important in the process. BACKGROUND The process of social rehabilitation lacks conceptual and empirical understanding in Neurology because most rehabilitation programmes have focused on cognitive and physical recovery. METHODS An action research project was undertaken in two neurological wards of a highly specialized hospital in Spain, and was completed in 2006. A social rehabilitation programme based on the assessment of social needs and individualized social education was planned with health professionals, and implemented and evaluated with patients and carers. Several instruments were used to explore how patients and carers perceived the process of social rehabilitation before and after the programme: semi-structured interviews, socio-demographic forms, field notes, participant observations, and scales of activities of daily living, social impairment and adjustment. Comparative content and statistical analyses were undertaken. FINDINGS Social rehabilitation was identified as a dynamic process in which the environment, activities, social interaction, self-recognition and awareness of social problems, coping and satisfaction played an essential role. Some defining criteria for social rehabilitation related to patients' and carers' attitudes, behaviour and the external implications that the socialization process had for them. CONCLUSION This study shows the advantages of multidisciplinary work, and user and family involvement in social rehabilitation and provides in-depth knowledge about how patients and carers experience and could face barriers to develop a role in their family environment, social groups and society.
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Ustinova K, Chernikova L, Bilimenko A, Telenkov A, Epstein N. Effect of robotic locomotor training in an individual with Parkinson's disease: a case report. Disabil Rehabil Assist Technol 2011; 6:77-85. [DOI: 10.3109/17483107.2010.507856] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Smania N, Corato E, Tinazzi M, Stanzani C, Fiaschi A, Girardi P, Gandolfi M. Effect of Balance Training on Postural Instability in Patients With Idiopathic Parkinson’s Disease. Neurorehabil Neural Repair 2010; 24:826-34. [PMID: 21045119 DOI: 10.1177/1545968310376057] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Postural instability (PI) is a disabling sign of Parkinson’s disease (PD) not easily amenable to treatment with medication. Objective. To evaluate the effects of balance training on PI in patients with PD. Methods. A total of 64 patients with PI were randomly assigned to the experimental group (n = 33) for balance training or to the control group (n = 31) for general physical exercises. Each patient received 21 treatment sessions of 50 minutes each. Patients were evaluated by a blinded rater before and after treatment as well as 1 month posttreatment using the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), postural transfer test, self-destabilization of the center of foot pressure test, number of falls, Unified Parkinson’s Disease Rating Scale (UPDRS), modified Hoehn and Yahr (H&Y) Staging Scale, and Geriatric Depression Scale (GDS). Results .At the end of treatment, the experimental group showed significant improvements in all outcome measures, except for the UPDRS and the H&Y scale. Improvement was maintained at the 1-month follow-up in all outcome measures except for the GDS. No significant changes in performance were observed in the control group. Conclusions. A program of balance training can improve PI in patients with PD.
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Affiliation(s)
- Nicola Smania
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy, Centro di Ricerca in Riabilitazione Neuromotoria e Cognitiva (CRRNC)
| | - Elisabetta Corato
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
| | - Clementina Stanzani
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
| | - Antonio Fiaschi
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy, IRCCS Ospedale S. Camillo Venezia-Lido, Venice, Italy
| | - Paolo Girardi
- Department of Medicine and Public Health, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy, Centro di Ricerca in Riabilitazione Neuromotoria e Cognitiva (CRRNC)
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Nijkrake MJ, Keus SHJ, Overeem S, Oostendorp RAB, Vlieland TPMV, Mulleners W, Hoogerwaard EM, Bloem BR, Munneke M. The ParkinsonNet concept: development, implementation and initial experience. Mov Disord 2010; 25:823-9. [PMID: 20461798 DOI: 10.1002/mds.22813] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The quality and efficiency of allied health care in Parkinson's disease (PD) must be improved. We have developed the ParkinsonNet concept: a professional regional network within the catchment area of hospitals. ParkinsonNet aims to: (1) improve PD-specific expertise among allied health personnel, by training a selected number of therapists according to evidence-based guidelines; (2) enhance the accuracy of referrals by neurologists; (3) boost patient volumes per therapist, by stimulating preferred referral to ParkinsonNet therapists; and (4) stimulate collaboration between therapists, neurologists, and patients. We describe the procedures for developing a ParkinsonNet network. Our initial experience with this new concept is promising, showing an increase in PD-specific and a steady rise in the patient volume of individual therapists.
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Affiliation(s)
- Maarten J Nijkrake
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre (RUNMC), Nijmegen, The Netherlands
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Döbrössy M, Busse M, Piroth T, Rosser A, Dunnett S, Nikkhah G. Neurorehabilitation with neural transplantation. Neurorehabil Neural Repair 2010; 24:692-701. [PMID: 20647502 DOI: 10.1177/1545968310363586] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cell replacement therapy has been tested clinically in Parkinson's disease (PD) and Huntington's disease (HD), epilepsy, spinal cord injury, and stroke. The clinical outcomes have been variable, perhaps partly because of the differing levels of preclinical, basic experimental evidence that was available prior to the trials. The most promising results have been seen in PD trials, with encouraging ones in HD. A common feature of most trials is that they have concentrated on the biological and technical aspects of transplantation without presupposing that the outcomes might be influenced by events after the surgery. The growing evidence of plasticity demonstrated by the brain and grafts in response to environmental and training stimuli such as rehabilitation interventions has been mostly neglected throughout the clinical application of cell therapy. This review suggests that a different approach may be required to maximize recovery: postoperative experiences, including rehabilitation with explicit behavioral retraining, could have marked direct as well as positive secondary effects on the integration and function of grafted cells in the host neural system. The knowledge gained about brain plasticity following brain damage needs to be linked with what we know about promoting intrinsic recovery processes and how this can boost neurobiological and surgical strategies for repair at the clinical level. With proof of principle now established, a rich area for innovative research with profound therapeutic application is open for investigation.
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Neurorééducation des syndromes parkinsoniens. Rev Neurol (Paris) 2010; 166:196-212. [DOI: 10.1016/j.neurol.2009.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 10/28/2009] [Indexed: 11/19/2022]
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Munneke M, Nijkrake MJ, Keus SH, Kwakkel G, Berendse HW, Roos RA, Borm GF, Adang EM, Overeem S, Bloem BR. Efficacy of community-based physiotherapy networks for patients with Parkinson's disease: a cluster-randomised trial. Lancet Neurol 2009; 9:46-54. [PMID: 19959398 DOI: 10.1016/s1474-4422(09)70327-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Many patients with Parkinson's disease are treated with physiotherapy. We have developed a community-based professional network (ParkinsonNet) that involves training of a selected number of expert physiotherapists to work according to evidence-based recommendations, and structured referrals to these trained physiotherapists to increase the numbers of patients they treat. We aimed to assess the efficacy of this approach for improving health-care outcomes. METHODS Between February, 2005, and August, 2007, we did a cluster-randomised trial with 16 clusters (defined as community hospitals and their catchment area). Clusters were randomly allocated by use of a variance minimisation algorithm to ParkinsonNet care (n=8) or usual care (n=8). Patients were assessed at baseline and at 8, 16, and 24 weeks of follow-up. The primary outcome was a patient preference disability score, the patient-specific index score, at 16 weeks. Health secondary outcomes were functional mobility, mobility-related quality of life, and total societal costs over 24 weeks. Analysis was by intention to treat. This trial is registered, number NCT00330694. FINDINGS We included 699 patients. Baseline characteristics of the patients were comparable between the ParkinsonNet clusters (n=358) and usual-care clusters (n=341). The primary endpoint was similar for patients within the ParkinsonNet clusters (mean 47.7, SD 21.9) and control clusters (48.3, 22.4). Health secondary endpoints were also similar for patients in both study groups. Total costs over 24 weeks were lower in ParkinsonNet clusters compared with usual-care clusters (difference euro727; 95% CI 56-1399). INTERPRETATION Implementation of ParkinsonNet networks did not change health outcomes for patients living in ParkinsonNet clusters. However, health-care costs were reduced in ParkinsonNet clusters compared with usual-care clusters. FUNDING ZonMw; Netherlands Organisation for Scientific Research; Dutch Parkinson's Disease Society; National Parkinson Foundation; Stichting Robuust.
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Affiliation(s)
- Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Nieuwboer A, Baker K, Willems AM, Jones D, Spildooren J, Lim I, Kwakkel G, Van Wegen E, Rochester L. The short-term effects of different cueing modalities on turn speed in people with Parkinson's disease. Neurorehabil Neural Repair 2009; 23:831-6. [PMID: 19491396 DOI: 10.1177/1545968309337136] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Turning has been associated with instability, falls, and freezing in people with Parkinson's disease (PD). OBJECTIVE To investigate the effect of different modalities of rhythmic cueing on the duration of a functional turn in freezers and nonfreezers. METHODS A total of 133 patients with idiopathic PD while in the on phase of the medication cycle participated in this study as part of a subanalysis from the RESCUE trial. The effect of 3 different cue modalities on functional turning performance was investigated, involving a 180 degrees turn while picking up a tray. Time to perform this task was measured using an activity monitor. Tests were performed without cues and with auditory, visual, and somatosensory cues delivered in a randomized order at preferred straight-line stepping frequency. RESULTS Cueing (all types) increased the speed of the turn in all subjects. There was no difference between turn performance of freezers and nonfreezers in cued and noncued conditions. Auditory cues made turning significantly faster than visual cues (P < .01) but not compared with somatosensory cues, except in nonfreezers. There was a short-term carryover in the final noncued trial. CONCLUSIONS Rhythmical cueing yielded faster performance of a functional turn in both freezers and nonfreezers. This may be explained by enhancing attentional mechanisms during turning. Although no harmful effects were recorded, the safety of cueing for turning as a therapeutic strategy needs further study.
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McAuley JH, Daly PM, Curtis CR. A preliminary investigation of a novel design of visual cue glasses that aid gait in Parkinson's disease. Clin Rehabil 2009; 23:687-95. [DOI: 10.1177/0269215509104170] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Parkinson's disease is a relatively common progressive neurodegenerative disorder, one of whose main features is difficulty with walking. This can be partially corrected by providing cues for the placement of each step. We piloted the potential benefit of simple custom-designed `walking glasses' worn by the patient that provide visual and auditory cues to aid in step placement. Design: We used a repeated measures design to compare gait performance when unaided and when using the walking glasses with different patterns of visual and auditory stimulation by timing patients' walking over a `real-life' predefined 30-m course. Setting: Hospital outpatient clinic. Subjects: Fifteen patients with idiopathic Parkinson's disease who had significant gait problems and no other condition affecting gait performance. Main measures: Timed walk. Results: Using the glasses, 8 of 15 patients achieved a significant and meaningful average improvement in walking time of at least 10% (mean (95% confidence interval) improvement in these patients was 21.5% (3.9%)), while a further 2 had subjective and modest objective benefit. Different patterns of visual and auditory cues suited different patients. Visual cueing alone with a fixed horizontal cue line present all the time statistically resulted in the greatest improvement in walking time. Conclusions: This pilot study shows promising improvement in the gait of a significant proportion of Parkinson's disease patients through the use of a simple, inexpensive and robust design of walking glasses, suggesting practical applicability in a therapy setting to large numbers of such patients.
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Affiliation(s)
- JH McAuley
- Department of Neurosciences, Royal London Hospital, Whitechapel, UK,
| | - PM Daly
- Department of Clinical Physics, Royal London Hospital, Whitechapel, UK
| | - CR Curtis
- Department of Clinical Physics, Royal London Hospital, Whitechapel, UK
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Keus SH, Munneke M, Nijkrake MJ, Kwakkel G, Bloem BR. Physical therapy in Parkinson's disease: Evolution and future challenges. Mov Disord 2008; 24:1-14. [DOI: 10.1002/mds.22141] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Clinimetric analyses of the Modified Parkinson Activity Scale. Parkinsonism Relat Disord 2008; 15:263-9. [PMID: 18691929 DOI: 10.1016/j.parkreldis.2008.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 06/20/2008] [Accepted: 06/20/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The Parkinson Activity Scale (PAS) is designed for functional assessment in Parkinson's disease (PD), but the scale has - in its current form - several drawbacks. The objectives of the present study are to (a) introduce a Modified PAS, with unambiguous scoring options and without ceiling effect; (b) evaluate the inter-rater agreement, using physiotherapists with and without PD-specific expertise; and (c) examine the concurrent validity with the VAS-Global Functioning and the UPDRS-III. METHODS The Modified PAS was developed based on the results of a recent pilot feasibility study [Keus SHJ, Bloem BR, van Hilten JJ, Ashburn A, Munneke M. Effectiveness of physiotherapy in Parkinson's disease: The feasibility of a randomised controlled trial. Parkinsonism Relat Disord 2007; 13(2):115-21.]. To evaluate inter-rater agreement, the Modified PAS was scored by a large number of raters (n=13) in 15 patients (Hoehn and Yahr stage 2-4), thus yielding a high number of observations (n=195) and creating adequate power. To ascertain broad applicability of the results, both physiotherapists with and without PD-specific expertise participated. RESULTS The interquartile range of the Modified PAS total scores was 40-51, within a possible range of 0 (optimal performance) to 56 (worst performance), suggesting lack of ceiling effect. The precision of these scores was 2.6 points, with an inter-rater error of 1.3 and a patient-induced error of 2.3. There were no differences between experts and non-experts. Correlation to Global Functioning (0.79) and UPDRS-III (0.64) was good. CONCLUSION The Modified PAS showed no ceiling effect, good concurrent validity, good inter-rater agreement and no differences between experts and non-experts.
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Mak MK, Hui-Chan CW. Cued task-specific training is better than exercise in improving sit-to-stand in patients with Parkinson's disease: A randomized controlled trial. Mov Disord 2008; 23:501-9. [DOI: 10.1002/mds.21509] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Keus SHJ, Bloem BR, Hendriks EJM, Bredero-Cohen AB, Munneke M. Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research. Mov Disord 2007; 22:451-60; quiz 600. [PMID: 17133526 DOI: 10.1002/mds.21244] [Citation(s) in RCA: 274] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Physical therapy is often prescribed in Parkinson's disease. To facilitate the uniformity and efficacy of this intervention, we analyzed current evidence and developed practice recommendations. We carried out an evidence-based literature review. The results were supplemented with clinical expertise and patient values and translated into practice recommendations, developed according to international standards for guideline development. A systematic literature search yielded 6 systematic reviews and 23 randomized controlled trials of moderate methodological quality with sufficient data. Six specific core areas for physical therapy were identified: transfers, posture, reaching and grasping, balance, gait, and physical capacity. We extracted four specific treatment recommendations that were based on evidence from more than two controlled trials: cueing strategies to improve gait; cognitive movement strategies to improve transfers; exercises to improve balance; and training of joint mobility and muscle power to improve physical capacity. These practice recommendations provide a basis for current physical therapy in Parkinson's disease in everyday clinical practice, as well as for future research in this field.
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Affiliation(s)
- Samyra H J Keus
- Department of Physical Therapy, Leiden University Medical Center (LUMC), The Netherlands
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Nieuwboer A, Kwakkel G, Rochester L, Jones D, van Wegen E, Willems AM, Chavret F, Hetherington V, Baker K, Lim I. Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial. J Neurol Neurosurg Psychiatry 2007; 78:134-40. [PMID: 17229744 PMCID: PMC2077658 DOI: 10.1136/jnnp.200x.097923] [Citation(s) in RCA: 549] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity. METHODS A single-blind randomised crossover trial was set up, including 153 patients with Parkinson's disease aged between 41 and 80 years and in Hoehn and Yahr stage II-IV. Subjects allocated to early intervention (n = 76) received a 3-week home cueing programme using a prototype cueing device, followed by 3 weeks without training. Patients allocated to late intervention (n = 77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a 6-week follow-up without training. Posture and gait scores (PG scores) measured at 3, 6 and 12 weeks by blinded testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain. RESULTS Small but significant improvements were found after intervention of 4.2% on the PG scores (p = 0.005). Severity of freezing was reduced by 5.5% in freezers only (p = 0.007). Gait speed (p = 0.005), step length (p<0.001) and timed balance tests (p = 0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p = 0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention had reduced considerably at 6-week follow-up. CONCLUSIONS Cueing training in the home has specific effects on gait, freezing and balance. The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson's disease.
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Affiliation(s)
- A Nieuwboer
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium.
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Nijkrake M, Keus S, Kalf J, Sturkenboom I, Munneke M, Kappelle A, Bloem B. Allied health care interventions and complementary therapies in Parkinson's disease. Parkinsonism Relat Disord 2007; 13 Suppl 3:S488-94. [DOI: 10.1016/s1353-8020(08)70054-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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O'Dell SJ, Gross NB, Fricks AN, Casiano BD, Nguyen TB, Marshall JF. Running wheel exercise enhances recovery from nigrostriatal dopamine injury without inducing neuroprotection. Neuroscience 2006; 144:1141-51. [PMID: 17157992 DOI: 10.1016/j.neuroscience.2006.10.042] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Revised: 10/26/2006] [Accepted: 10/28/2006] [Indexed: 11/17/2022]
Abstract
Forced use of the forelimb contralateral to a unilateral injection of the dopaminergic neurotoxin 6-hydroxydopamine can promote recovery of motor function in that limb and can significantly decrease damage to dopamine terminals. The present study was conducted to determine (1) whether a form of voluntary exercise, wheel running, would improve motor performance in rats with such lesions, and (2) whether any beneficial effects of wheel running are attributable to ameliorating the dopaminergic damage. In experiment 1, rats were allowed to run in exercise wheels or kept in home cages for 2 1/2 weeks, then given stereotaxic infusions of 6-hydroxydopamine into the left striatum. The rats were replaced into their original environments (wheels or home cages) for four additional weeks, and asymmetries in forelimb use were quantified at 3, 10, 17, and 24 days postoperatively. After killing, dopaminergic damage was assessed by both quantifying 3 beta-(4-iodophenyl)tropan-2 beta-carboxylic acid methyl ester ([(125)I]RTI-55) binding to striatal dopamine transporters and counting tyrosine hydroxylase-positive cells in the substantia nigra. Exercised 6-hydroxydopamine-infused rats showed improved motor outcomes relative to sedentary lesioned controls, effects that were most apparent at postoperative days 17 and 24. Despite this behavioral improvement, 6-hydroxydopamine-induced loss of striatal dopamine transporters and tyrosine hydroxylase-positive nigral cells in exercised and sedentary groups did not differ. Since prior studies suggested that forced limb use improves motor performance by sparing nigrostriatal dopaminergic neurons from 6-hydroxydopamine damage, experiment 2 used a combined regimen of forced plus voluntary wheel running. Again, we found that the motor performance of exercised rats improved more rapidly than that of sedentary controls, but that there were no differences between these groups in the damage produced by 6-hydroxydopamine. It appears that voluntary exercise can facilitate recovery from partial nigrostriatal injury, but it does so without evident sparing of dopamine nerve terminals.
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Affiliation(s)
- S J O'Dell
- Department of Neurobiology and Behavior, 1452 McGaugh Hall, University of California, Irvine, Irvine, CA 92697, USA.
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Abstract
OBJECTIVE To review existing studies evaluating the effectiveness of physical exercise on mortality, strength, balance, mobility, and activities of daily living (ADL) for sufferers of Parkinson's disease (PD). DATA SOURCES The following databases were searched (1) Cochrane Database of Systematic Reviews, (2) Cumulative Index to Nursing and Allied Health Literature (CINAHL), (3) PubMed and (4) Medline/NARIC (National Rehabilitation Information Center) using combinations of key words Parkinson's disease and physical exercise. Only articles written in English were included. References cited were also examined. STUDY SELECTION Studies were eligible if (1) only patients with PD were included in the intervention study (there were many studies that evaluated the benefits of exercise after stroke, cardiac arrest, sports injuries, surgery, and arthritis, but only a few for patients with PD), (2) the intervention included some form of physical or therapeutic exercise, (3) the effects of the physical exercise were evaluated, and (4) the studies were published in a refereed journal. Because few studies were found that dealt with PD patients exclusively, all studies that evaluated the effectiveness of physical exercise for only PD patients were included. Seven studies met our criteria and were selected. Three of the selected studies were randomized controlled studies, 1 was an open trial, and the other 3 relied on patients' own assessments. DATA SYNTHESIS Outcomes in the studies were measured in terms of physical improvements in patients with PD, such as improved axial rotation, functional reach, flexibility, balance, muscle strength, short-step gait, and mobility. All studies reviewed show that exercise improves overall performance in PD patients. Improvements were measured using standardized tests and other measurement scales. CONCLUSIONS The results of the present research synthesis support the hypothesis that patients with PD improve their physical performance and activities of daily living through exercise. Future studies should include the development of standardized exercise programs specific for problems associated with PD as well as standardized testing methods for measuring improvements in PD patients. There is also a need for longer term studies (over 1 year) to assess if improvements achieved during the intervention stage are retained long term.
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Ellis T, de Goede CJ, Feldman RG, Wolters EC, Kwakkel G, Wagenaar RC. Efficacy of a physical therapy program in patients with Parkinson’s disease: A randomized controlled trial. Arch Phys Med Rehabil 2005; 86:626-32. [PMID: 15827910 DOI: 10.1016/j.apmr.2004.08.008] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the effects of a physical therapy (PT) program in groups of people with Parkinson's disease (PD). DESIGN Randomized controlled trial with a crossover design. SETTING Two outpatient rehabilitation clinics in Boston and Amsterdam, respectively. PARTICIPANTS Sixty-eight subjects diagnosed with typical, idiopathic PD, Hoehn and Yahr stage II or III, and stable medication use. INTERVENTION Group A received PT and medication therapy (MT) for the first 6 weeks, followed by MT only for the second 6 weeks. Group B received only MT for the first 6 weeks and PT and MT for the second 6 weeks. MAIN OUTCOME MEASURES The Sickness Impact Profile (SIP-68), the mobility portion of the SIP-68, the Unified Parkinson's Disease Rating Scale (UPDRS), and comfortable walking speed (CWS) at baseline, 6-week, 12-week, and 3-month follow-up. RESULTS At 6 weeks, differences between groups were significant for the SIP mobility ( P =.015; effect size [ES]=.55), for CWS ( P =.012; ES=.49), for the activities of daily living (ADL) section of the UPDRS ( P =.014; ES=.45), and for the total UPDRS ( P =.007; ES=.56). The total SIP and the mentation and motor sections of the UPDRS did not differ significantly between groups. Significant differences were found at 3 months compared with baseline for CWS, the UPDRS ADL, and total scores. CONCLUSIONS People with PD derive benefits in the short term from PT group treatment, in addition to their MT, for quality of life related to mobility, CWS, and ADLs; long-term benefits were found in CWS, UPDRS ADL, and total scores but varied between groups.
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Affiliation(s)
- Terry Ellis
- Sargent College of Health and Rehabilitation Sciences, Department of Rehabilitation Sciences and Center for Neurorehabilitation, Boston University, MA 02215, USA.
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Lim LIIK, van Wegen EEH, de Goede CJT, Jones D, Rochester L, Hetherington V, Nieuwboer A, Willems AM, Kwakkel G. Measuring gait and gait-related activities in Parkinson's patients own home environment: a reliability, responsiveness and feasibility study. Parkinsonism Relat Disord 2005; 11:19-24. [PMID: 15619458 DOI: 10.1016/j.parkreldis.2004.06.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Revised: 06/10/2004] [Accepted: 06/18/2004] [Indexed: 10/26/2022]
Abstract
The aim of this study was to assess reliability, responsiveness and feasibility of gait and gait related tests in the home of patients with Parkinson's disease (PD). The Unified Parkinson's Disease Rating Scale, a timed walking test, the Timed Get Up and Go test the Berg Balance Scale and the Functional Reach test were applied by three independent observers on 26 PD patients. Moderate to high Intraclass Correlation Coefficients were found, ranging from 0.74 to 0.88 and 0.64 to 0.87 for the intra- and inter-observer reliability, respectively. All test showed Reliable Change Indexes under 11% and the whole test battery was applicable within 30 min.
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Affiliation(s)
- L I I K Lim
- Department of Physiotherapy, VU University Medical Center (VUmc), Amsterdam, The Netherlands.
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Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena. Mov Disord 2004; 19:871-84. [PMID: 15300651 DOI: 10.1002/mds.20115] [Citation(s) in RCA: 786] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Falls and freezing of gait are two "episodic" phenomena that are common in Parkinson's disease. Both symptoms are often incapacitating for affected patients, as the associated physical and psychosocial consequences have a great impact on the patients' quality of life, and survival is diminished. Furthermore, the resultant loss of independence and the treatment costs of injuries add substantially to the health care expenditures associated with Parkinson's disease. In this clinically oriented review, we summarise recent insights into falls and freezing of gait and highlight their similarities, differences, and links. Topics covered include the clinical presentation, recent ideas about the underlying pathophysiology, and the possibilities for treatment. A review of the literature and the current state-of-the-art suggests that clinicians should not feel deterred by the complex nature of falls and freezing of gait; a careful clinical approach may lead to an individually tailored treatment, which can offer at least partial relief for many affected patients.
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Affiliation(s)
- Bastiaan R Bloem
- Department of Neurology, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
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Gage H, Storey L. Rehabilitation for Parkinson's disease: a systematic review of available evidence. Clin Rehabil 2004; 18:463-82. [PMID: 15293481 DOI: 10.1191/0269215504cr764oa] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To systematically review the available evidence on the effectiveness of nonpharmacological rehabilitation interventions for people with Parkinson's disease, and identify future research needs. DESIGN Electronic searches of four databases (CINAHL, Cochrane Library, MEDLINE, PsychLIT) 1980-2002; examination of reference lists of relevant papers. Controlled trials and observational studies were included. Data extraction and quality assessment of papers by two independent reviewers. A narrative review. SETTING Rehabilitation interventions delivered either in subjects' own homes, or in clinical settings as outpatients. SUBJECTS Community-living adults with Parkinson's disease. INTERVENTIONS Physiotherapy, occupational therapy, speech and language therapy, psychological counselling and support, and education. MAIN MEASURES A range of outcomes: mobility, functional status, speech, swallowing, psychological well-being, as determined by the studies included in the review. RESULTS Forty-four different studies (reported in 51 papers) were included (25 physiotherapy, 4 occupational therapy, 10 speech and language therapy, 3 psychological counselling, 1 educational, 1 multidisciplinary). All studies, except one, reported improvements on at least one outcome measure. CONCLUSIONS Findings may reflect publication bias, but suggest interventions can affect patients' lives for the better in a variety of ways. It is difficult to interpret the clinical importance of statistically significant improvements reported in most studies. There is a need for methodologically more robust research with meaningful follow-up periods, designed in a manner that separates specific and nonspecific effects. Cost-effectiveness evidence is required to provide clear guidance on service extensions.
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Affiliation(s)
- Heather Gage
- Department of Economics, University of Surrey, Guildford, Surrey GU2 7XH, UK.
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Abstract
Physical therapy can improve performance of balance tests in patients with Parkinson's disease. Parkinson's disease is a chronic progressive neurological disturbance with significant effect on movements, cognitive functions, autonomous systems and psychosocial activities. The effects of physical therapy are rarely reported and not sufficiently studied. This prospective study comprised 40 persons with stage III Parkinson's disease, according to aged over 50 years and 20 healthy controls of the same age. Patients were medically stable and had no other neurological deficits, postural hypotensia, visual disturbances or musculo-skeletal deficits. Balance tests before and after physical therapy were analysed according to. Balance tests in patients with Parkinson's disease resulted in significant differences of values for tandem stance, one leg stance, step test and external perturbation when compared to the controls, and between groups with and without falling tendency. Tandem stance, one leg stance, step test and external perturbation can be used for differentiation between groups with and without a tendency to fall. Physical therapy resulted in significant improvement of these tests in both the groups analysed. Systematic application of physical therapy, as part of team treatment, improves the balance of patients with Parkinson's disease.
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Affiliation(s)
- Ivona Stankovic
- Clinic for Physical therapy and rehabilitation, University Clinical Center Nis, Nis, Yugoslavia.
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Abstract
Corticobasal degeneration is one of the neurodegenerative tauopathies, which are defined as a group of heterogeneous dementias and movement disorders that are characterized neuropathologically by prominent intracellular accumulations of abnormal filaments formed by the microtubule-associated protein tau. Although there are no curative treatments, symptomatic and supportive management can be helpful. Many new therapies are still under development. However, more needs to be learned about the pathogenesis and molecular biology of this disease before an effective therapy can be developed.
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Affiliation(s)
- Panida Piboolnurak
- *The Neurological Institute, Columbia University, 710 West 168th Street, New York, NY 10032, USA.
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Nieuwboer A, De Weerdt W, Dom R, Bogaerts K. Prediction of outcome of physiotherapy in advanced Parkinson's disease. Clin Rehabil 2002; 16:886-93. [PMID: 12501951 DOI: 10.1191/0269215502cr573oa] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Prediction of the effect of a home physiotherapy intervention on the basis of four clinical characteristics of patients with advanced Parkinson's disease. DESIGN A repeated measures design comparing six weeks without treatment with six weeks of physiotherapy and a follow-up of 12 weeks. SUBJECTS Persons with Parkinson's disease without dementia and suffering from considerable functional disability. INTERVENTION Community physiotherapists treated patients in the home situation three times a week teaching cueing and conscious movement control for walking and carrying out transfers in and out of beds and chairs. MAIN OUTCOME MEASURES Mental status, disease severity, age and mood were included as predictor variables. A new functional scale developed as part of a previous study was used as the dependent variable administered in both the hospital and the home to determine whether the outcome generalized from the learning to a different environment. RESULTS Only disease severity was a negative predictor of treatment outcome at home. In the hospital setting none of the factors predicted the immediate effect of treatment but cognitive ability and age were determinants of whether the treatment effects were maintained in the long term. CONCLUSIONS Using cueing and cognitive strategies benefited younger and older patients with Parkinson's disease alike. However, the findings indicate targeting of treatment at patients with milder disease severity and providing follow-up treatment for older and cognitively less able patients.
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Affiliation(s)
- Alice Nieuwboer
- Department of Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, Katholieke Universiteit Leuven, Heverlee, Belgium.
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